Few Boomers Screened for Hep C

Test Fail
Few boomers are getting screened for hep C
by Larry Buhl

In 2012, the U.S. Centers for Disease Control (CDC) and the U.S. Preventative Services Task Force (USPSTF) announced that Americans born between 1945 and 1965, the so-called baby boomer cohort, should get tested for the hepatitis C virus (HCV). One rationale was that prior to 1992, blood banks did not screen for HCV, and people receiving transfusions before then could have been exposed. The CDC estimated that testing all boomers would identify 800,000 infections, and with linkage to care and treatment, would prevent more than 120,000 HCV-related deaths. The CDC also estimated that boomer testing would save between $1.7 and $7.1 billion in liver disease-related costs.

But boomers don’t seem to have gotten the message. A study published in in the July 2017 issue of American Journal of Preventive Medicine showed that less than fourteen percent of the boomer cohort had been tested. A study published in the August 2017 in Public Health Reports, found that less than three percent were screened for hepatitis C in the year following the CDC’s recommendation.

Another study, published in March in Cancer Epidemiology, Biomarkers & Prevention, which explored the rates of testing for Americans born between 1945 and 1985, found that females were less likely to get tested for hep C than males. Researchers also found that HCV testing rates were lower among Latinos and Blacks compared with whites.

According to Tom Nealon, President and CEO of the American Liver Foundation, stigma about HCV and physician ignorance are keeping people from getting screened.

“People come up to me and say ‘I wasn’t an IV drug user,’ so I can’t have [HCV],’” Nealon told A&U. “And worse, they say, ‘my primary care physician said to me, ‘you weren’t an IV drug user, so you don’t need to get tested.’ The primary care physicians are the biggest obstacle to testing. They don’t know enough about it.”

Though Nealon says patients should be advocates for their own health, he also believes they’re being hindered by misinformation about the disease.

“People are reluctant to find out they have liver disease and won’t ask their doctor to test them,” Nealon said. “I can understand five years ago before there was a cure. You can now get cured. Most insurance plans will cover the cost of the test.”

Some states, including Pennsylvania and New York, require physicians to offer hepatitis C testing to all boomers who visit a clinic or primary care doctor for a check up, or who are admitted to a hospital for any reason. In 2015 the University of Michigan Health System launched an automated electronic medical alert that notifies a doctor if a patient falls into the at-risk age group. The alert urges physicians to offer HCV screening and provide patients with educational materials.

HCV can spread through contact with an infected person’s blood, but the infection typically doesn’t produce any symptoms. Most infected people eventually develop chronic HCV infection and many of those will require liver transplants. According to the CDC, up to 4.7 million Americans are living with HCV.

Nealon would also like to see more states to follow the lead of Pennsylvania and New York, but also be proactive about educating primary care doctors about the importance of HCV screening.

For its part, the Liver Foundation’s web site, liverfoundation.org, and helpline, 800-goliver, as well as occasional PSAs, offer valuable information. But Nealon says what would really help is a celebrity endorsement for testing.

“There has to be someone like Taylor Swift or Lady Gaga or whoever that could make some statement or a Tweet. They could say I have a family member or friend with liver disease, or a relative whose life was saved because they were tested and treated.”

“If, say, Ebola were coming to the U.S. and there was a cure, people would clamor for it,” Nealon said. “If there’s a disease affecting an estimated four million Americans, why not get them tested, treated and cured?”

Previous treatments for hepatitis C, including ribavirin and interferon, were lengthy and arduous, but protease inhibitors and even newer antiretroviral treatments for HCV can eliminate the virus in a fraction of the time. Many insurers cover at least one of the newer antiretroviral meds.

Boomers account for more than seventy-five percent of Americans with HCV, and an estimated one in thirty boomers are infected with the virus. In addition to the boomer cohort, The USPSTF recommends HCV testing for incarcerated people, those who use intranasal drugs and people who get tattoos from unregulated artists.

The growing opioid epidemic, however, might soon produce a rival cohort at risk of HCV infection. The CDC found that in 2016, the highest overall number and rates of new hepatitis C infections were among people in their twenties.

Larry Buhl is a multimedia journalist, screenwriter, and novelist living in Los Angeles. Follow him on Twitter @LarryBuhl.